I had to turn in a co worker...help

[nuseetravelgirl]

I was working with a nurse the other day that has been at our facility for years. Myself and a few people noticied that she had not been acting right that day, especially in the afternoon. We were in the back med room together early afternoon and I noticed her trying to give a controlled substance to a pt, she had a dose with her that was twice the dose and she also wanted to give another narc. The pt didnt need either one of these meds, the first one she tried to give was written Qhs and the other she wanted to give to relax him. This is a pt we all know well and take turns taking care of and he had just gotten up from bed and started his day, he certainly wasnt ready to fall back asleep. After she and I drew up the correct amount of the second narc she was never seen giving it and as I was wasting it she wanted me to leave her some extra in the syringe, why?

When the pyxis report was pulled by the adn after a few of us reported her, it turns out she pulled out three times the amount of the first controlled substance that she wanted to give, 3 vials of benadryl and the second narcotic that she supposedly gave!!!!

She also almost made a major med error involving my pts meds, which all of a sudden went missing and she half admitted that she might have mixed them up into her pts meds when crushing the meds, but the tried to get out of her admission.

It was from this point on that she slurred her speech, couldnt sustain normal conversation, seemed tired, dissapeared off the unit leaving her pts without giving me report for 10-15 minutes at a time. I had another nurse come over to watch my pts for a few and she seemed to think the other nurse wasnt acting right.

This is a nurse is is liked and has been there awhile. Me, Ive been there for only a short time but I felt my obligation to report her not acting right had to be carried out. Now I am feeling like everyone at work is pointing fingers at me, she was escorted out by two ADNs close to change of shift. They are all talking about me and and I know it, there is a nurse telling me things that are being said. The funny thing is, is that no one really knows what went down except myself and the ADN and manager, but people have their assumptions and stories and are now hating me. Will people get over this and let it go and stop talking about this? Im feeling like I need to quit, I feel harrassed in an indirect manner knowing everyone is pointing fingers at me and talking about me, but I know I did the right thing......help I feel upset about all of this and amm looking for another job.

[ragingmomster, BSN, MSN, RN]

Keep your head up.

You did nothing wrong, if admin hadn't found anything she wouldn'a been escorted anywhere.

This nurse dragged you into a mess with narcotics that you don't need on your license.

Good job.

[madwife2002, BSN, RN]

You did the right thing, those mistakes are too huge to cover up. If she is innocent she will be able to explain, the errors. It would frighten the life out of me to discover what you have discovered. The other nurses are probably just taking about it and it seems like they are pointing the finger at you. Afterall no body in their right mind could turn a blind eye to what you have seen-nobody, unless they were guilty too.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

What a mess. No one likes to turn in a co-worker, esp. one who has been there a long time. But it would be your license if you noticed these things and didn't say anything. And what if she injured a pt due to her being high, and you didn't say anything? You would never forgive yourself. You did the right thing, and Im sure it was difficult. People will talk. Im sure they are mad about loosing a long time nurse, not specifically mad at you. They are probably mad they didn't notice similar behaviors. I hope that she receives the help that she needs, and can get her life and career back on track. You did the right thing!!

[irmaRN]

i agree that you did the right thing, absolutely!! we had a nurse that worked in our er on night shift who was caught in the act... one thing i always try to keep in mind.... what if this nurse was taking care of one of my family members... we must and always should be advocates.. good job..

[Psychaprn]

I have a good friend (R.N.)with a narc addiction who was turned in and she's in recovery now. She says she might have died if she wasn't turned in and is now thankful to the nurse who turned her in. Instead of assuming everyone's talking about you try talking to people directly. If thery disagree with what you did-forget them. Don't quit-you sound like an honest, caring nurse!

[RNOTODAY, BSN, RN]

Pardon my ignorance, I havent worked med surge in my nursing career, so...

With Pyxis systems, how is it that nurses can divert these narcotics, isnt there a record of who took what and when?????

Thanks for your help...

[babynurselsa, RN]

Yes with the pyxis system you log on and sign out meds under a specific patients name. All the diverter has to do is go and sign out pain meds under a patient though. If the amounts seem excessive then usually pharmacy has a little red flag and they may investigate. On a med surg floor nearly everyone usally has a prn ordered so all she would need to do is document that everyone got a requested prn.

I only know this because we had a traveler one place I worked a couple of years ago that pharmacy arrived mid shift to discuss with the charge nurse that one individual had drawn out an insane amount of narcs just part way through a shift. When they went to looking nearly none of them had been ordered. She left with the police.

[nuseetravelgirl]

Thanks everyone for your supportive comments. THere should be some mechanism in the pyxis to stop you once you've taken out the correct dose of a med, if its due only qhs, you shouldnt be allowed to take it out early or more than once that day unless you get a new order or a pharmacy overide. There is room for improvement with the pyxis system for sure.

This nurse was able to take out the pt's dose three times within 20 minutes! Yikes.

[babynurselsa, RN]

THe pyxis system can actually be set up this way. It is up to your pharmacy.

Some places I work on the floors you may only pull meds that are on the pts profile. To get anything else you must override which requires a second nurse to cosign with you. Other places you may get to whatever is in the pyxis.

Like I said though pharmacy reviews all withdrawls and if someone is taking out inordinate amounts this will raise a flag.

[jannrn]

I had to turn in a co-worker once. I had a very busy night and was not able to chart times for several meds, so went back to the pyxis to get the activity record to get exact times to chart. In the process I noticed a co-worker had removed a large amt of a narcotic on my pt. I then went back and checked her activity record (it keeps the last 24 hrs, probably more for the pharmacists) and she had taken some on another pt (who was not ordered for it so she used override, no witness needed then) I printed this info out, wrote a letter to nurse manager, got feedback from a fellow co-worker who agreed with my findings and we never saw her at work again. Other co-workers wondered and wondered what happened to her but I don't know if anyone ever found out. I asked to be anonymous. A couple years later I saw her name in the state board of nursings list of RN's as one who voluntarilly surrendered her license. I was shocked, but now I know it can happen.... I was very sad, she was fun to work with.

[ZASHAGALKA, RN]

In the process I noticed a co-worker had removed a large amt of a narcotic on my pt.

The problem w/ diverting is that you CAN just take out PRNs that you don't give for your pts and keep them for yourself.

THIS WILL WORK. But, only for awhile.

But the nature of addiction is like a law of nature. As that addiction grows, a nurse will be unable to conceal diversion in that way. And the result is ever more 'daring' behavior: overriding for narcs not ordered, or, more likely, withdrawing PRN narcs for pts they aren't taking care of. That's easier to conceal.

I've worked on big units and seen my share of diverters. I ALWAYS, as a standard of care for my pts, check the 'pt usage' on all my pts at the end of my shift. If somebody else signed out a narc on one of MY pts that I didn't personally request they give for me: I write that up to my manager AND send a note to pharmacy. I've had to do that twice in my career. First time, after investigation, it was an honest mistake (signed out a sedative on MY pt; meant to sign out the same sedative on the pt next to mine on the pyxis list.) The other time: diverter.

It's such a simple matter for a diligent pharmacy to catch diverters. A simple standard deviation plot is all it would take. Diverters would be so far outside the standard deviation that they would make the most aggressive pain control nurse look tame by comparison.

I don't know why hospitals aren't more diligent about this. Maybe they don't WANT to know - and that's scary. Bottom line: this shouldn't have been left up to you; it should have been caught before. You maybe could have been more discreet and anonymous but that's water under the bridge.

Be cool for awhile. Sometimes things do blow over. But, you may find that you DO need to find another job. In any case, you did the right thing. Doing the right thing sometimes costs. I would give it some time. The people mad at you know you did the right thing, even as they 'rally' around their friend.

~faith,

Timothy.